tramadol hydrochloride

tramadol hydrochloride

(tram' ah doll)

Ultram

Pregnancy Category C

Drug class

Analgesic, centrally acting

Therapeutic actions

Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin; causes many effects similar to the opioids—dizziness, somnolence, nausea, constipation—but does not have the respiratory depressant effects.

Indication

·        Relief of moderate to moderately severe pain

Contraindications and cautions

·        Contraindicated with allergy to tramadol or opioids or acute intoxication with alcohol, opioids, or psychoactive drugs.

·        Use cautiously with pregnancy, lactation, seizures, concomitant use of CNS depressants or MAOIs, renal dysfunction, or hepatic impairment.

Available forms

Tablets—50 mg

Dosages

ADULTS

Patients who require rapid analgesic effect: 50–100 mg PO q 4–6 hr; do not exceed 400 mg/day.

Patients with moderate to moderately severe chronic pain: Initiate at 25 mg/day in the morning and titrate in 25-mg increments q 3 days to reach 100 mg/day. Then, increase in 50 mg-increments q 3 days to reach 200 mg/day. After titration, 50–100 mg q 4–6 hr; do not exceed 400 mg/day.

Patients with cirrhosis: 50 mg q 12 hr.

Patients with creatinine clearance < 30 ml/min: 50–100 mg PO q 12 hr. Maximum 200 mg/day.

PEDIATRIC PATIENTS

Safety and efficacy not established.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT

> 75 yr: Do not exceed 300 mg/day.

Pharmacokinetics

Route	Onset	Peak
Oral	1 hr	2 hr

Metabolism: Hepatic; T_1/2: 6–7 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

Adverse effects

·        CNS: Sedation, dizziness or vertigo, headache, confusion, dreaming, sweating, anxiety, seizures

·        CV: Hypotension, tachycardia, bradycardia

·        Dermatologic: Sweating, pruritus, rash, pallor, urticaria

·        GI: Nausea, vomiting, dry mouth, constipation, flatulence

·        Other: Potential for abuse, anaphylactoid reactions

Interactions

Drug-drug

·        Decreased effectiveness with carbamazepine

·        Increased risk of tramadol toxicity with MAOIs

Nursing considerations

Assessment

·        History: Hypersensitivity to tramadol; pregnancy; acute intoxication with alcohol, opioids, psychotropic drugs or other centrally acting analgesics; lactation; seizures; concomitant use of CNS depressants or MAOIs; renal or hepatic impairment; past or present history of opioid addiction

·        Physical: Skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP; bowel sounds, normal output; LFTs, renal function tests

Interventions

·        Control environment (temperature, lighting) if sweating or CNS effects occur.

·        WARNING: Limit use in patients with past or present history of addiction to or dependence on opioids.

Teaching points

·        You may experience these side effects: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals).

·        Report severe nausea, dizziness, severe constipation.

Adverse effects in Italic are most common; those in Bold are life-threatening.